White spot lesions or enamel demineralization around fixed orthodontic attachments affect the esthetic outcome of a successfully completed orthodontic case. The purpose of this article is to review the evidence regarding evaluation, prevention and treatment of white spot lesions in orthodontic patients and to provide clinical recommendations useful for both the general dentist and the orthodontist. Apart from routine oral hygiene instructions additional measures including fluoride varnish, xylitol chewing gum, chlorhexidine mouth rinse, dietary modifications and calcium containing remineralisation products are effective in the prevention and treatment of white spot lesions. Treatment of white spot lesions can range from the most conservative to the most aggressive procedures involving tooth reduction and porcelain veneers.
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